- Insurer participation in the individual Affordable Care Act exchanges rose in 2019, according to a new report from McKinsey & Company. The findings show continued strength of the ACA marketplace even amid Republican attempts to undermine the law.
- In the 2019-2020 plan year, 245 individual carriers participated across the federal and state exchanges, compared to 218 carriers last year and 194 in the 2017-2018 plan year. Coverage and choice also grew, as the number of U.S. counties with only one insurance provider shrank from 36% in 2019 to 25% in 2020.
- The findings come as the Supreme Court convenes Friday to decide whether to review the Republican lawsuit seeking to overturn the ACA.
The nation's highest court may decide Friday whether to take up Texas v. United States, the lawsuit helmed by a cadre of Republican states challenging the law's constitutionality, during its next term starting in October. If they decide to take the case, Supreme Court justices will weigh whether to uphold a lower court's decision affirming the ACA's individual mandate as unconstitutional and that the law can't stand without it.
The Supreme Court also has the option to relist the case for a conference date in the future, delaying the choice altogether.
Some 20 million Americans would lose insurance if the ACA is overturned, the Commonwealth Fund estimates. The Trump administration has chipped away at key tenets of the law through measures like virtually eliminating funding for advertising and consumer navigation, promoting short-term plans slammed by critics as 'junk' insurance, halving the enrollment period and eliminating cost-sharing subsidies paid to insurers.
Despite those measures, however, 2020 enrollment in the exchanges remained essentially stable at 8.3 million. And the McKinsey analysis of county and plan level information re-ups evidence that the law is basically chugging along as planned.
Exchange participation rose in 2019 and 2020 following three subsequent years of decline, though the number of carriers has not yet recovered from its 2015 high of 333.
Consumers have access to a greater range of carriers, as one-fifth of U.S. counties only have one insurer in 2020. Only about one in 10 people have to shop between plans offered by one carrier in their county, and two-thirds can choose from three or more carriers.
McKinsey also found better prices in the exchanges, especially in states with reinsurance programs. Premiums for all metal tiers except platinum declined between the 2018 and 2019 plan years, with regional and local plans seeing the greatest decreases.
While divisive in its early years, the law has grown more popular. A clear majority, or 55%, of the public views the ACA favorably, according to the latest tracking poll from the Kaiser Family Foundation. That's its highest rating since KFF polling began since it was signed into law nearly a decade ago.
Additionally, repealing the law is no longer at the top of Republican voters' healthcare wish lists. Instead, lowering healthcare costs and opposing single-payer and "Medicare for All" plans top conservative health priorities for 2020, KFF found.